DE3935256C1 - - Google Patents

Abstract

The insertion device has a flexible insertion section (14) which can be introduced into an object to be examined, especially a human colon, having an intermediate space (20) sealable against the outside between an inner (16) and outer wall (18). The outer wall (18) consists of a flexible pipe which cannot be expanded by the fluid in the intermediate space (20). The inner wall (16) of the insertion section (14) is also a pipe and can be deformed radially inwards by the fluid introduced into the intermediate space (20) and laid against the outer wall (18) by evacuating the intermediate space (20). The insertion section (14) can be rendered rigid in any position by evacuating the intermediate space (20). It is easy to introduce the appropriate instrument, e.g. a colonoscope (50) into the object to be examined through the insertion section (14) thus secured. The insertion section (14) becomes flexible again when the intermediate space (20) is filled with a fluid, e.g. air.

Description

The invention relates to an insertion device for tubular fiber optic instruments, especially colo noscopes, with a handle and one in a sub object, especially human colon, insertable, flexible insert that is between an inner tube and an outer wall at least one sealed to the outside Has space into which a fluid is introduced leaves.

Have tubular fiber optic instruments, e.g. is known from US 46 96 544, areas of application also outside of medicine, for example for examining Pipelines, vessels and machine parts. Corresponding is also the term object under investigation within the scope of the to understand the present invention.

There are insertion devices for introducing colonoscopes in use, which is a one-piece hose from an im Comparison to the associated colonoscope with high flexural strength have speed that only relatively minor ela allows static bending. The inside diameter of a such a tube for a colonoscope with 15 mm outside diameter knife is, for example, just under 16 mm, so that the Slightly push the colonoscope through at any time. The  The outer diameter of the hose is, for example, 19 mm.

The insertion part is 40 cm long; the length of the associated Colonoscopes are usually between 130 and 180 cm.

A distal end of the colo about 10 cm long noscopes can be positioned at the proximal end Adjusting wheels usually in four directions (up / down and left / right).

The colonoscope is the examining or treating Doctor inserted into the colon from the anus. So that one full examination of the colon is possible, it must Colonoscopes are advanced to the coecum. It leaves the direction of movement of the colonoscope with it determine the movable distal end area. Still surrender on the bends of the colon, namely on the sigmoid and especially with the two colonic flexures, regular problems with risk of injury, pain for the patient and convulsive contractions of the colon to the point of impossibility possibility to continue the investigation. These problems are related to the fact that the colon is soft and only is relatively little attached in the abdomen. The main line the force with which the colonoscope is advanced after a redirection no longer runs in the direction of distal end of the colonoscope, but on the slightly yielding wall of the colon, which is unanimous for the patient is approving. Therefore, in about 10 to 15% of all cases of the Coecum cannot be reached.

These difficulties can be solved with the common ones Only partially overcome introducers as they do Colonoscope only through the rectum and at most that Sigmoid and descending colon can guide. Late but they remain at the left colonic flexure written problems exist. It is also used by many Patients already found it uncomfortable that the sigmoid an almost straight course from the hose  is forced because the shape of the hose is not arbitrary is changeable. Because of the high rigidity of the hose pipe, there is a risk of careless handling that the colon is perforated.

From DE 36 05 169 A1 is a mechanical-pneumatic Ma nipulation system for colonoscopes known, in which with an insertion device of the gat described above the introduction of a colonoscope for the doctor and patient should be facilitated. One belongs to the insertion device flexible slide tube into which the colonoscope slides ben, and on which a balloon or a group of balloons is arranged from highly flexible material. The balloon or the balloon group is firmly attached to the in the deflated state Sliding tube on; in the inflated state, the bal lon or the group of balloons in the area, i.e. on the Support the inner wall of the intestine and the shaft of the knockout lonoscopes moved forward or back with the help of a mechanism can be. A second group of balloons on the Kolo If the nosepiece is firmly attached, it will be vented if that Colonoscope compared to that supported in the area Sliding tube is to be moved and is inflated, if the slide tube together with its balloon or balloon group should be moved. The sliding tube is longitudinal channels, one of which is pressure and vacuum lines and another a mechanical pull and push system men should.

This known insertion device with an outside arrangement neten inflatable balloon or group of such bal lons can insert a colonoscope into a human lichen intestine not much easier since the intestine on every stretch, regardless of whether it's from an untied protected colonoscope or by one or more blown balloons is evoked in the same way with spastic, painful contractions responded. Such  Contractions also occur distal to the colonoscope and complicate its further forward movement. For not medical examination objects, such as Machine parts that have sharp-edged inner contours can, the known insertion device is suitable because the sensitivity to injury of a balloon assembly not the flexible sliding tube.

The same applies to one from DE 28 23 025 C2 known device for transporting a colonoscope, at the distal end of the colonoscope through a thin everted tube with the distal end of a cone shaped tube that is connected in human Anal ring is insertable. On the proximal end of the tube a housing can be screwed on to move the colonoscope around closes and has a connecting piece. Will through a pressure medium is introduced into the connecting piece, then a section between the two hose ends of the tube pushed into the colon, where he pulls out and pulls the colonoscope with it. This So it should be by pulling and not by thrust into the intestine be moved. When the hose penetrates, the The inner part is turned inside out so that he then forms an outer tube part facing each other the intestinal mucosa does not move. This also allows each painful spastic intestinal contractions be opened. Even if it is with this well-known Vorrich tion, a colonoscope is sufficiently wide, in particular In any case, it is not possible to advance to the Coecum Lich to leave the tube in the intestine and use it as a help fe to re-insert the colonoscope if this, for example to remove a larger polyps, has been temporarily removed. The reversible and is suitable for technical applications therefore not necessarily thin tube since it is on sharp edges and protrusions of the object under examination can tear easily.

The invention is therefore based on the object Insertion device for tubular fiber optic In to design instruments, in particular colonoscopes, in such a way that full and, if necessary, multiple insertion such an instrument until the end of the investigation object much easier and with medical Un makes examinations more tolerable for the patient and for simplified the doctor.

According to the invention, the task is based on a one guiding device of the type described above thereby solved that

• - The outer wall of a flexible, but from the fluid in Interspace not outer balloon inflatable ge forms is, and
• - The inner tube by introduced into the space Fluid deformable radially inwards and by evacuation of the space can be placed on the outer tube.

The inner and outer tubes together form a slide-in part that in any, the sigmoid and even the two Colonic flexures of adjusted bending can be stiffened by the space is evacuated so far that the inner tube at least in spots or stripes on the outer tube. The insert part deformed and fixed in this way allows the associated instrument, esp. colonoscope, ratio insert moderately easily. Then like in the space who introduces a fluid, the insert part wins its original flexibility back.

The inner tube, which is preferably softer than the outer tube is, by introducing a fluid under pressure, at for example compressed air, the inner tube in the space of the insertion part firmly to that through the insertion device instrument passed through it, in particular a colonoscope be without  that the outer tube is inflated. Has in this state the insertion device leaves its greatest flexibility because of its temporarily fixed connection with the Advance the fiber optic instrument together with this. This can be done by alternately pushing the instrument alone and the instrument with insertion device the end the examination area, especially the Coecum, without any problems can be achieved.

It is particularly useful if the space supports contains body, over which the inner tube and the outer Support the pipe to each other when the pressure in the gap falls below a predetermined amount. The support body can protrusions of the inner tube and / or the outer tube in the form of warts, spirals, ribs or the like. be. As Support bodies are also loosely attached in the space ordered balls, for example made of polystyrene.

Part of the support body is preferably on the outside side of the inner tube and the rest of the Support body firmly attached to the inside of the outer tube arranges. The fixed arrangement can be in one piece Production of the support body with the associated interior or outer tube or by gluing, melting or Vulcanization of separately manufactured support bodies surrender.

A particularly strong mutual interlocking and thus high flexural rigidity of the evacuated insert results itself when the support body that is on the outside of the Inner tube are arranged in a gap between each Engage support bodies on the inside of the outer tube.

The space can be divided into several chambers, which can be evacuated individually or together and if necessary can be put under pressure. Such chambers can  for example by welding seams or other seams from be separated from each other, the kind of stitching that Connect the inner tube to the outer tube. The chambers can straight or helical along the insertion part extend. Inner and outer tube can be between the Chambers form uniform wall areas.

An embodiment of the invention is as follows with further details using schematic drawings explained. Show it:

Fig. 1 is an overall view of an introducer according to the invention with associated structures Appara,

Fig. 2 shows the cross section II-II in a large enlargement and

FIGS. 3a-f six consecutive manipulations of a colonoscope with guide tube.

The main components of the insertion device 10 shown are a handle part 12 and an insertion part 14 . To a slide part 14 include an inner tube 16 , an outer tube 18 , an annular space 20 formed between them, a distal end region 22 in which the inner tube 16 is tightly connected to the outer tube 18 and thereby the inter mediate space 20 is closed, and finally a di staler guide ring 24 .

The handle portion 12 consists essentially of an inner sleeve 26 to which the inner tube 16 is tightly attached, and an outer sleeve 28 to which the outer tube 18 is BEFE sealed. Inner tube 16 and outer tube 18 can, for example, be vulcanized, glued and / or tightly clamped onto the associated sleeve 26 or 28 . The two sleeves 26 and 28 are tightly connected to one another in their proximal end region, for example screwed. On the outer sleeve 28 or in a connection area between this and the inner sleeve 26 , a connection 30 for a conduction and suction of a fluid in or out of the inter mediate space 20 is arranged.

Inner tube 16 and outer tube 18 consist of flexible, body-compatible plastic; the inner tube 16 has a smaller wall thickness than the outer tube 18 and can therefore also be easily deformed radially inward if an excess pressure is generated in the intermediate space 20 ; the outer tube 18 , on the other hand, is so firm and possibly reinforced with fibers that it cannot be inflated by a pressure prevailing in the intermediate space 20 , which already noticeably deforms the inner tube 16 .

Support bodies 32 are arranged uniformly distributed on the outer wall of the inner tube 16 ; gaps 34 are left between them. In a corresponding manner, 18 support bodies 36 and gaps 38 are arranged on the inner wall of the outer tube such that each support body 32 of a gap 38 , and each support body 36 of a gap 34 is radially opposite. As long as ambient pressure prevails in the intermediate space 20 , the support bodies 32 and 36 do not touch one another or at most loosely. However, if the intermediate space 20 is evacuated to a greater or lesser extent, each support body 32 engages in a gap 38 and each support body 36 engages in a gap 34 . As a result, the insertion part 14 is stiffened in any shape that it had taken before evacuation.

To use the insertion device according to the invention, the connection 30 is connected via a hose 40 to a control device 42 of a conventional type, which connects the hose 40 to a compressed air line 46 or a vacuum line 48 , for example by actuating a rocker-like switch 44 . A commercially available colonoscope 50 is inserted with its distal end 52 ahead into the proximal end of the guide tube 10 and pushed through the handle part 12 and insert part 14 .

The further handling of the insertion device 10 and colonoscope 50 takes place on the patient and is shown in FIGS . 3a to 3f. It means the common representation of the guide tube 10 and the colonoscope 50 as a thick line that air (or another fluid) with excess pressure is introduced into the space 20 and thereby the inner tube 16 has been firmly attached to the colonoscope 50 ; the insertion part 14 is then just as flexible as the colonoscope 50 . The representation of the insertion device 10 as a thin, distinguishable line pair from the colonoscope 50 , on the other hand, means that there is a negative pressure in the insertion part 14 , in which the inner tube 16 releases the colonoscope 50 for relative displacements and lies firmly against the outer tube 18 , so that the insertion part 14 is stiffened.

According to FIG. 3a, the colonoscope 50 is inserted into the colon 60 with the flexible insert part 14 firmly attached to it, initially from the anus 62 through the rectum 64 until the transition from the sigmoid 66 to the colon de scendens 68 . In this position, the insert part 14 is stiffened by evacuating its space 20 .

Referring to FIG. 3b, the endoscope 50 is direction by the Einführvor 10 therethrough with stiffened insertion portion 14 up to the splenic flexure 70 is further pushed.

According to FIG. 3c, the stiffening of the insert part 14 is released again by introducing compressed air into its intermediate space 20 ; the sigmoid 66 is straightened somewhat, and the guide tube 10 is pushed up to the left colon flexure 70 .

In the position according to FIG. 3d, the insertion part 14 is stiffened again and the colonoscope 50 is pushed through the left colon flexure 70 .

According to FIG. 3e, the stiffening of the insertion part 14 has been removed again, and the insertion device 10 is pushed in beyond the left colon flexure 70 and then stiffened again; then the endoscope 50 is advanced to and beyond the right colon flexure 74 .

According to FIG. 3f, the stiffening of the insertion part 14 is released again; the guide tube 10 is pushed beyond the right colon flexure 74 and then stiffened like that, so that the colonoscope 50 can now be pushed further into the coecum 78 .

In each of the positions described and in all inter mediate positions of the introducer 10 , the colonoscope 50 can be pulled out completely in order to transport, for example, a tumor removed with a loop, which cannot be removed through the colonoscope 50 , to the outside. Subsequently, the colonoscope 50 can be inserted through the insertion device 10 which has remained in the stiffened state in the colon 60 , and, if necessary, further tumors can be removed and transported to the outside.

Claims (5)

1. Insertion device ( 10 ) for tubular fiber-optic instruments, in particular colonoscopes ( 50 ), with an insertable, flexible insertion part ( 14 ), which can be inserted into an examination object, in particular a human colon ( 60 ), between an inner tube ( 16 ) and one Outer wall has at least one outwardly sealed space ( 20 ) into which a fluid can be introduced, characterized in that

• - The outer wall is formed from a flexible outer tube ( 18 ) which cannot be inflated like a balloon by the fluid in the intermediate space ( 20 ), and
• - The inner tube ( 16 ) in the intermediate space ( 20 ) directed fluid deformable radially inward and by evacuating the intermediate space ( 20 ) to the outer tube ( 18 ) can be applied.

2. Insertion device according to claim 1, characterized in that the inner tube ( 16 ) is softer than the outer tube ( 18 ). 3. Insertion device according to claim 1 or 2, characterized in that the intermediate space ( 20 ) contains support body ( 32 , 36 ) over which the inner tube ( 16 ) and the outer tube ( 18 ) are supported against each other when the pressure in the intermediate space ( 20 ) falls below a predetermined amount. 4. Insertion device according to claim 3, characterized in that a part of the support body ( 32 ) on the outside of the inner tube ( 16 ) is fixed and the rest of the support body ( 36 ) on the inside of the outer tube ( 18 ) is fixed. 5. insertion device according to claim 4, characterized in that the support body by ( 32 ), which are arranged on the outside of the inner tube ( 16 ), in each a gap ( 38 ) between support bodies ( 36 ) on the inside of the outer tube ( 18 ) intervene.